Confessions of a trauma therapist

I don’t think there was ever any teaching on trauma in the counselling training I did. But when I was doing my student placement during my diploma, it was mentioned that there was a person who was losing time, and they wondered if this person might actually be dissociated. I was asked if I would be willing take her on. To prepare for this, I read the book When Rabbit Howls – that was all I knew about dissociative identity disorder. The whole thing was alarming for me and so unreal and unnatural. How could anyone have more than one personality? I was also very squeamish about anything to do with Satan or the Devil – I wouldn’t even say the words. I was a vicar’s wife, and wanted nothing to do with this side of life at all. I couldn’t have been more ill-prepared or more naїve. But I met with this lady and during the very first session a young child part appeared. She was sussing me out, talking to me and telling me her name and I sat there, absolutely thunderstruck and frozen, thinking, “Now what do I do?!” I had no idea at all, but I just spoke back to this little one as I would to a child. I tried to be totally honest and welcoming, as if this was the most natural thing in the world to do – which of course it is now – but back then I was thinking, “What have I done? How do I get back to Sarah?” And so when we started approaching the end of the session, I asked nervously, “Could Sarah come back please?” and back she came. She had been mid-sentence when she had broken off and switched, and she picked up exactly where she had been and finished her sentence. I was absolutely bewildered, shocked and amazed. So that’s how I started.

And then more child parts came, one after the other, and I grew to love them and they became very special to me. Somehow, despite my ignorance and lack of training, we developed a therapeutic alliance, and we began to work together. We figured out that each alter had had a part to play in the trauma and had had a special job to do, with special training, under torture and duress and so on. And we went from there. Everything I knew, everything that I began to know, this client taught me. She had no idea that she was dissociative because she wasn’t in the slightest bit co-conscious. She just knew that she would find herself at a funfair or an airport or so on, and not know how or why she had got there. So to start with in our work we just tried to figure out a very basic kind of timeline of her life, because she didn’t have the faintest idea whether yesterday was yesterday or six years go. Her life was absolutely chaotic with this whole sense of unreality. She had no idea whether things had really happened or whether she had invented them, because everything that was real felt like a dream, and everything that was a dream felt real.It was the King’s Cross fire that was the turning-point, because she had been caught up in it. She was one of the passengers and had been asked to leave, so she sat outside on the pavement. And she told me all about it in an unreal kind of way, what she was wearing, where she was sitting, but all the time thinking it was a dream. Then she saw it on the news, and it dawned on her that it had actually happened, that she hadn’t made it up – she realised all of a sudden that some of the things in her head were real.

We worked on what I would now call mapping her internal system, but the whole idea of there being a ‘system’ or a ‘family’ was entirely new to me then. We discovered more and more little ones, and teenagers, and personalities of all ages who had been forced to do the most terrible things. And the teenage parts wanted nothing to do with the little ones, so we worked on getting them to relate to each other, to understand why they were there, how it wasn’t their fault. It was wonderful when they all began to work together and listen to each other and hear each others’ needs and so on. I’ve got a theoretical framework to put that in now – internal attachment – but back then it was intuitive and I couldn’t have explained it if I’d tried.

I was horrified at the atrocities I was hearing that had happened to this person, and I was phoning my supervisor every day, really just to calm myself down. It shocked me to the core, and I wouldn’t have coped without that support. We realised that there were all these inside people who wanted to come and talk and that the session itself wasn’t enough to hear everyone, so as well as making each session longer, we arranged that once a month she would come on a Saturday morning just to play. But in her play I couldn’t believe what I was seeing and hearing: “Oh, you don’t want to go home, that’s horrible that, that’s the worst place to be.” And what she was doing with the toys was explicitly showing me sex of every imaginable variety.

Somehow we muddled along together to find ways that would help her. One of these ways was me telling a rescue story and blowing the house down afterwards, rescuing the child to make it all better and then telling off the people that had hurt her, sending them away and so on. We used to tell this story over and over again, and it helped. We worked a lot with story and toys and play, but really it was the relationship we had that got us through.

One of the leaps forward was when we went away once together, to Nicholaston House in Wales. We drove down there and it was mind-blowing for me to realise that this child-adult had never been able to look at things because her whole attention had always been hypervigilant, just to be on guard, looking out for what was going to happen to her next. I remember that we looked at blackberries, and she had no idea what they were. Then ferns – all completely new. Now, years later, she’s become an authority on these things because she’s learned to look and notice and be curious. But back then it was as if she was seeing things for the very first time, and it blew me away. And I hadn’t realised how so many things could be triggers. We came across a flock of birds, just harmless ducks and geese, and these were terrifying for her; she would be triggered, and off she would go. I had a very steep learning curve in those days. But I’m struck by how powerful and effective therapy can be, when I stop and think about the fact that this client has now been on falconry courses and excelled at her career and overcome so much.

It could only have been the strength of the relationship that got us through. I had no idea about neuroscience, and had very little appreciation of attachment theory. I have chased training ever since, beginning with Penny Parks Inner Child Therapy, then Sensorimotor Psychotherapy, and Lifespan Integration as well as a lot of CPD on trauma. And I’ve bought libraries of books – whatever was available I’ve wanted to read, to know and understand what was going on, to be better at helping, because therapy with DID survivors is such a long and painful process. So I’ve always wanted to learn anything I can that will make it easier and less arduous for the client. Many times I tried to refer my client on to someone who could help her better, not because I didn’t want to work with her, but because I cared for her and wanted her to have the best. But there seemed to be nobody, nobody at all. Fortunately nowadays there are more trauma specialists, but still too few.

Through it all I have been rocked to the core by realising the depravity that people, the perpetrators, are capable of. In contrast the DID clients I have had have been the most beautiful, the most loving people I have ever met on this whole earth. They have a compassion and a humaneness and a gentleness and they have shown me more love than I have dreamt was possible. But I’ve been appalled at what has been done to them, the calculated evil they have been brought up with, the vileness of the gratuitous violence they have suffered, and the distress of their shame and humiliation. What really took me by surprise was realising that this is organised abuse, often by people with respectable jobs and beautiful houses and smart Savile Row suits. And it is these people who in many cases are the ‘pillars of society’ who have deceived and tricked children, tortured them, and destroyed their lives and their beliefs about themselves and others. Yet somehow through it all, these wonderful clients of ours have stayed alive and had the courage to endure therapy, which is extremely painful. It takes a huge amount of courage to go through therapy with this kind of stuff, so I admire them all enormously.

I have come to understand that so much of what goes on during the abuse is a manipulation and perversion of a child’s innate attachment needs, where the child is invited to love a kitten or a puppy, and then that animal might be killed and they are forced to eat it. And the way that abusers use the magical thinking of the child to terrorise them into silence: “We’ve planted eyes in you so that whatever you do we can see you.” One of my clients was made to believe that there were hidden cameras watching her every time she was in the bath, and there was just this awful sense of humiliation and shame, of being watched and having no privacy, that messed with her mind in such a subtle yet such a damaging way.

Sometimes, with the play therapy part of things, I’ve seen child parts tell their story through acting it out with little Playmobil men, because they are under orders not to ‘tell’ with words, but they desperately need to communicate it somehow. And I can remember my horror at watching a scene unfold in the sandtray, watching a row of little people against the wall, then sitting up, then lying face down and bang, bang, bang went the adult Playmobil men, and I heard myself say, “Gang-rape!” And it was such a shock for my client to hear it described in those terms – these unencoded memories that a child-part had acted out in the sandtray, suddenly verbalised so insensitively by me. I was horrified; I thought, “What have I done? I’ve retraumatised her.” And to an extent I did, and we had to work that through, but eventually it did help her too, to come to terms with the severity and awfulness of what had happened to her. It was as if she could only understand it for herself once she had seen it reflected in me as a mirror. She was surprised that I was so appalled at it, because to her it had been normal, and she had never anticipated that anyone would mind. So even my blunders sometimes helped – which was reassuring.

Some of the most challenging aspects of it for me was understanding that for this child-adult, the rape wasn’t the worst part of it. I hadn’t been able to conceptualise that anything could be worse than rape, and so I hadn’t really understood my client’s mental living space. But then one day one of her alters explained to me that they felt relief when it was ‘only rape’. I had been constricted by my belief that rape was the pinnacle, the apogee of how bad it had been, and I hadn’t really understood the sense that came through sometimes of relief, even gratitude, in telling the story of particular traumatic incidents which had only involved rape, or gang-rape. I kept missing what she was trying to tell me because torture and being made to murder and then consume flesh, or blood, or semen, hadn’t been part of my worldview. I have found that clients won’t tell me what they don’t think I will believe.

Engaging so deeply with such traumatic material, in an intersubjective relationship where you can’t help but care so profoundly for someone, always runs the risk of secondary traumatisation, and I take that risk very seriously. I’m fortunate to be in a very stable, long-term, loving and supportive marriage. But I’m also beginning to take ‘spaces’ very seriously – not just holidays, but going out to lunch and doing different things, creative activities like flower-arranging workshops where you use your hands, that sort of thing. And I’ve become a training junkie – not just to learn more, but for myself as me as well, because meeting with other people who work in this area too is enormously supportive and helps you realise that you’re not alone, and you’re not insane. You begin to think, “Can these things really happen?” but then because you’re hearing it from different people all over the country, you think, “Yes, this happens – and it’s huge.” It is global, and calculated, and big money.

But usually it’s the little things that upset me. Like the mother who knowingly lets abusers take her child off to harm her and then leaves her a cup of milk for when she gets home. Or one client who told me about the most horrendous rape and torture that went on, and then sitting at the table for tea straightaway afterwards, sitting straight, elbows off the table, that kind of thing, and someone insisting that she had another potato. She’d been forced to ingest the most awful, horrendous substances, and then someone is pretending that it’s all happy families and normal and she has to eat a second potato. That really got to me. I just get so upset about the little things, because they take me off-guard, perhaps because they make it more real. Perhaps I’m more prepared for the big things, or more defended against them, but the little things, the personal details – they really bother me.

But it’s so important for me to be able to cope with this stuff because if I can’t, how can my clients? I’ve got to be a secure, safe, soothing presence who can contain their ‘stuff’ and hold it for them for a little while, and give it back, transmuted a little, perhaps slightly more bearable, so that they can own it and say, “Yes, this is my stuff.” But that takes a lot of time, and a lot of courage on their part. I’ve learnt a very little about how to use the body to deal with some of it, and doing the Sensorimotor training has been absolutely fascinating because you come to realise that the body has its own story, and that if you listen to the body you can actually process stuff without retraumatising. It’s wonderful to see a transformation where the trauma doesn’t haunt them any more.

It’s always a balancing act, and too often we’re riding right on the edge of being out of control, but the concept of working within the ‘window of tolerance’ has helped me enormously, as has the three-phase treatment model. I think it’s ideal if you can get stabilisation and safety first, and with one client we’ve taken things just extremely slowly for that very reason. We’ve hardly done anything trauma-related for two or three years, but she’s read books and when we’ve gone to the memories we’ve barely touched on them because it’s been too horrendous. So we go at the pace she can manage. Other clients are different – I have one who hurls herself headlong at full speed into everything and we have called it ‘white-water rafting’. I kept saying, “Slow down, slow down!” but in the end I figured that we’ve got to do things at her pace, so I jumped in a boat and paddled hard after her, so to speak. The approach you take has got to be so individual and unique for everyone you work with, because each client is so individual and unique. I just try to make the whole thing as least ghastly as possible for them; I try to get at least some level of stabilisation, because they’ve got lives to lead and can’t just disintegrate. But for some people safety isn’t possible, especially when there is ongoing contact with the perpetrating family, and maybe even ongoing abuse. One of the things I find hardest is the physical pain, because when the memories come back, often so does the pain. I have seen clients pass out with the intensity of the pain, and I don’t know any medication that copes with body pain remembered. So I’m forever feeling inadequate, that I don’t know enough and I desperately want to know more so that I can help in some way – what these dear people have been through as children is so awful, and I don’t want the working through of it for them to be any worse than it needs to be.

Attachment theory is hugely important to me now and what I really want to do right from the start with a client is to establish a safe environment, to be a secure base, to develop a relationship where the client is listened to and held and contained so that there can be some safe exploration. Obviously there is the trauma to explore, but so often there are a hundred other areas in their current life too, like relationship difficulties with partners or children or friends, problems with just maintaining some semblance of routine and normality while these intrusive dissociative states scream for attention. And there’s developmental trauma as well – all those limiting beliefs such as “I am bad”, “No one can be trusted”, “I don’t belong”, “I hate me”.

So many times it has felt that progress in therapy is signalled by destabilisation or disintegration, and at those times you really do have to have good supervision and a lot of faith in the process, a lot of understanding in what is going on, either in attachment terms or neurological terms, or both. Adah Sachs talks about how we can become a new type of attachment figure – ‘earned secure’ – but to do this you have to be there when the client is making their attachment cry. This mostly doesn’t happen during the session, when you want it to, when it would be convenient. It happens in between sessions, and – especially at certain times of the year – at night. I do a lot of my ‘work’ with clients outside the session: with emails, with telephone calls. For particular stages of therapy, usually when we’re processing trauma or there are particular threats to attachment security, the client needs to know every day that you’re still alive, because they think that you’re bound to die or to be killed, because they’ve started caring. Or they are struggling with some form of object constancy, and they can’t remember you, and there’s a panic that suddenly you don’t exist, that you’ve been annihilated – and this feels like they have been annihilated, that it’s a threat to their survival, so they spiral out of control in terms of emotions and autonomic reactions. In those instances I personally would prefer it if my clients phone me – when they’re having night terrors, or the pain has reached intolerable levels – just so that we can restabilise things, do some affect regulation, bring things back down into the ‘window of tolerance’. Then I find that gradually, over time, they learn to do it for themselves – they learn to self-soothe. One client says to me that I’m like a fire extinguisher on the wall – there in case of emergency – and just knowing that means that she can get on with her daily life and be ok, because she feels safe. I’ve found that a lot of memories, a lot of triggering, goes on in the night, especially around 3.00 am and I’ve done a lot of work on the phone at those times, talking to alters that wouldn’t come at 10.00 am or 11.00 am because they’re just programmed to come out at 3.00 am: programmed to go somewhere, to do something. I know that not everyone can cope with night-time stuff, but for some reason I’ve been able to and it’s been helpful, I think. I am fortunate in that I’m able to down-regulate myself and go back to sleep quite quickly and not be too affected by it.

I also do other wicked things like going out for a coffee with my clients, because I want them to know that they are human. They have had all the human taboos broken, so they don’t realise that they really are human and the same as everyone else, and deserving of the same courtesies and the same pleasures as everyone else, even simple things like a coffee and a cake in Costa. They don’t realise that they are nice people because so often they hate themselves so much, so I think it’s important to normalise things sometimes, to socialise or relate on a kind of everyday level too, to make sure that it’s not all trauma work with nothing balancing it up. For some it’s in those settings that they learn that they can ‘do people’, as one client puts it, that they can be just like ordinary friends meeting for a cup of coffee, that they’re not weird and damaged and beyond redemption. Sometimes the smallest, most basic, obvious things are the most therapeutic.

The crux issue for me within attachment is attunement. With disorganised attachment, and with clients who have been ritually abused in particular, you can very quickly become misattuned. Sometimes that happens simply because you’re not seeing things from your client’s perspective – you’re clueless, you have no idea that what you’ve just said or done was triggering, or unhelpful, or has other meanings. Sometimes it’s transference and it’s just that no matter what I do, I’ll be seen as ‘bad mother’. But often it’s more than that, and I’ve failed to meet my client in the middle where we’re both bringing our experiences and understanding of the world into play – I’m just oblivious to how different our perceptions or expectations might be. For example, one of my client’s alters would say, “I’m stupid” and for a long time I would say, “No, you’re not stupid – you’re very intelligent.” And I didn’t understand why this alter would then spiral further down into shame and a sort of anguish, of disconnection from me. But then over time I began to realise that this was a double whammy for them, because now I was in effect saying to them, “You’re wrong.” So they would think, “Well, I obviously am very stupid, because I got it wrong as well.” And being wrong, getting things wrong, was not just a source of shame and humiliation but was hugely dangerous for them previously – there had been repeated instances of torture when they ‘got it wrong’. So I’m a bit laboured now and I say, “Yes, I hear you say that you think you’re stupid … my experience is slightly different” and I try to validate their view of themselves first so as not to trigger shame or terror. Another source of misattunement was misreading my facial expression, because the constant dread or the constant expectation was that I was cross. The trouble is that I frown when I’m concentrating or thinking! I had no idea that fear of not getting it right, or someone being cross, was such a deep and embedded trauma.

I do believe very much in validation. So if someone is cutting themselves, far from saying, “Don’t do that!”, I would now try to find out what the cutting was trying to achieve, because I realise that every part, every alter, is doing something for the host person, for the team as a whole. So the cutting might be to give them a moment’s respite or peace or pain relief, or it might be a way of shouting, “Something is wrong here – do something!” Or it might be a re-enactment, telling the story of what happened – “This is what was done to me.” I became aware that just to be a witness to what happened can make a difference. I try to validate each and every part – because each part, each alter, is precious. I might try and look at what that alter had to do – the function they had to perform in order to survive, and try and change that, to encourage them to think about what they would like to do instead. But even in that I’ve learned to tread carefully, because in my eagerness to help I’ve often plunged in too quickly. There was an alter of one client who ‘ran’ – very definitely a ‘flight’ part, and we called her ‘Flee’. She ran from the abuse, and she ran like the wind in all the races at school. I suggested that she could sit down now and stop running, and dutifully she did. But later on in therapy I realised that it had become counter-productive because it was too soon in the process, that some of the energy and drive and efficacy had gone out of the client as a whole, because I’d interfered. Far better for Flee to have been integrated in her own way, and in her own time. The wisdom of the entire ‘system’ is immense and is wired for survival. The more I work with DID clients, particularly survivors of Ritual Abuse, the more I realise how amazing they are to have survived, and I know that I have to listen to them and their innate wisdom if I’m going to be of any use to them at all.

This has been a developmental journey, my own process. I still don’t know the answers, but am better able to hold the unknowing, able to stay with that unknowing and still be present. There are no certainties, no black and white or “This is the way to do it.” I used to worry about the ‘either/or’ dilemma, for example “Do I either work with the parts or with the wise adult?” I know now it is not ‘either/or’ but ‘both/and’. My focus is not so much on the doing of the work, but of being in the work, the ‘I-Thou’ relationship that Buber advocates. Any knowledge I might have been sure of has given way to the wisdom of the not knowing. I am learning – with a lot of help from my clients – to be energetically present, but not in their way.

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